The role of MRI in stroke care with Cerebriu Apollo

The role of MRI in stroke care with Cerebriu Apollo
© Luis Alvarez

Timely treatment is essential for the welfare of stroke patients – Cerebriu Apollo can help.

Today’s time to treatment for an acute stroke is too slow and needs to happen faster in order to save more lives. With the use of Artificial Intelligence (AI) technologies such as Cerebriu Apollo, it is now possible to enhance the use of fast MRI scans for suspected strokes, even skipping the initial CT scan altogether, and thereby create a better future for patients.

The World Health Organization (WHO) reports: ‘Annually, 15 million people worldwide suffer a stroke. Of these, five million die and another five million are left permanently disabled, placing a burden on family and community.’

A stroke can be defined as ‘a disease that involves the arteries leading to and within the brain becoming blocked or rupturing’. This means that part of the brain cannot get the blood it needs to survive. Whether the patient suffers from an ischemic (the artery becomes blocked) or haemorrhagic (the artery ruptures) stroke, time to treatment is key for acute strokes. A crucial component in treatment planning is imaging. Since Cerebriu was founded two years ago, significant benefits have already been detected. Faster and more personalised diagnostic imaging, including access to relevant data while the patient is still in the scanner, allows for a higher volume of patients per scanner while increasing scan and data quality.

Types of scans and their challenges

To detect acute strokes, hospitals carry out two types of scans:

  • CT scans are excellent at detecting a haemorrhagic stroke, and most general hospitals use non-contrast CT to detect a potential fresh bleed. The lack of a haemorrhage in the presence of stroke symptoms can rule out a haemorrhagic stroke and reveal a possible ischemic stroke instead; and
  • MRI scans, on the other hand, are superior to CT in the detection of acute ischemia.
  • Since the majority of acute strokes are ischemic, one would think that MRI scans would be more commonly used for the diagnosis of acute ischemia. Unfortunately, MRI scans are often not available for acute examinations, due to either MRI restrictions or lack of either MRI-neuroimaging expertise, MRI availability or image acquisition speed:
  • Restrictions: MRI imaging is restricted on patients with metallic implants or devices such as pacemakers;
  • MRI-neuroimaging expertise: if MRI scans should be used in all cases of ischemic stroke and made available 24/7, there would also need to be a neuroradiologist on call 24/7 – which unfortunately is not possible due to resource constraints. It is common within clinics for an MRI to be reviewed initially by a junior radiologist before the findings are confirmed by a neuroradiologist to ensure accuracy;
  • MRI availability: if an MRI is not rapidly accessible within a hospital, the potential for delays in imaging are a barrier to utilising MRI in the routine workup of a suspected stroke patient. MRI is quite often conducted following a CT scan, as part of routine stroke follow-up, also to rule out other pathologies. Some progressive hospitals are now moving dedicated MRI scanners into the Emergency Department (ED), working with very short protocols and in some cases skipping the CT entirely and going directly to MRI; and
  • Image acquisition speed: MRI, despite short stroke protocols of less than 10 minutes, is slower to complete than CT or CTA scans. Since timing is everything for strokes, the scan time is also something that is of great importance. However, in many situations, the effect on time to treatment is limited given the availability of MRI in the ED.
  • To help overcome many of these challenges, Cerebriu has built a platform, named Apollo, which operates during MRI scanning to provide a first impression; thereby reducing scan time and data to improve diagnostic turnaround time and reduce time to treatment.

Cerebriu Apollo platform

With the help of the Apollo platform, Cerebriu ensures the right data is collected for the right patient, to make the right clinical decision.

  • ‘Right data’ is about acquiring the needed sequences from a minimal routine protocol to detect strokes, while providing the needed imaging target for diagnostics and potentially intervention, for example by dynamically adding the MRI angiogram if an infarct is detected;
  • ‘Right patient’ reasoning ensures suspected acute stroke patients are triaged, while those without stroke or other clinically relevant findings could be discharged earlier instead of being admitted until adequate data is acquired following the initial stroke scan; and
  • ‘Right decision’ refers to the determination to treat or not to treat, admit or not to admit, improving the patient journey and potentially the outcome, while optimising use of resources in the clinical workflow. This ensures accurate guidance and improving confidence of the medical professionals available at that time. This could be an attending radiologist at night, when a neuroradiologist may not be available, or anyone making the first read before the neuroradiologist makes a final call and approves the report.

Apollo differs from current offerings on the market, due to the fact that an indication of potential findings in a patient’s MRI brain scan are available to the right stakeholders while the patient is in the scanner. Apollo uses the most basic and commonly used MRI sequences to detect the most critical findings in real time. This allows for more optimal and faster clinical decision making, starting from where to take the patient after leaving the scanner.

Often symptoms are diffuse, and with Apollo incidental findings can help exclude conditions including not only haemorrhages and infarcts, but also brain tumours. This saves time and helps prioritise patients not only in the ED but also in the routine clinic.

Cerebriu Apollo in the clinic

The key advantage of Cerebriu Apollo is that it can be easily inserted into existing radiology workflows.

From a clinical perspective, this means that in a hospital equipped to perform an acute MRI, a patient with symptoms of an acute stroke can immediately have three simple sequences acquired that provide the radiographer, radiologist, and referring clinician with three key pieces of information via Apollo’s analysis:

  • The first is whether there are signs of ischemia or haemorrhage in the images, and where these are located using a simple overlay directly onto the MRI images in the Apollo image viewer;
  • The second is information regarding what to do next, such as advice to perform a study to image the blood vessels in the brain to help guide treatment decisions; and
  • The third is automated triage, so that formal review of images with abnormalities can be prioritised over images with no findings, and in the ED setting, that acute patients can get faster treatment.

The result is that the correct sequences are acquired for the patient, staff are supported to make the correct clinical diagnosis, and treatment can be initiated in a more timely fashion. This information is available to all clinicians involved in the patient’s care, to help coordinate work-up, admission and intervention.

The future with Apollo

With platforms like Cerebriu Apollo in place, hospitals around the world can work towards a better future for patients with acute strokes thereby saving lives, avoiding morbidity, and reducing chronic disabilities.

We are on the right track and the demand for new technologies that can help overcome today’s many challenges of using MRI scans is increasing.

“At our hospital we provide 24/7 acute stroke diagnostics, using MRI during extended work hours, but relying on CT at night due to neuroradiologist shortage,” says Dr Michel Nemery, head of radiology at Herlev and Gentofte Hospital, Denmark. “We envision using MRI 24/7 to reduce time to treatment and unnecessary admissions, and improve patient journeys and outcomes, including to avoid doing both CT and MRI. We look towards promising next generation technology in the hope of realising our aspirations.”

Robert Lauritzen
Cerebriu A/S
+45 5383 0686

This article is from issue 15 of Health Europa. Click here to get your free subscription today.

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